After a decade of appropriate use criteria publication, the degree and predictors of inappropriate use in women compared with men are not known. We conducted a retrospective cohort investigation comparing appropriateness categories (appropriate, maybe appropriate, and rarely appropriate) and cardiovascular outcomes in patients undergoing nuclear myocardial perfusion imaging (MPI) between June 2011 and September 2014 in predominantly inpatient setting. Of 1,475 cases reviewed, 747 (50.6%) were women, and they were more likely to have rarely appropriate use 118 (15.8%) than men 62 (8.5%), p <0.01, but they were less likely to have an abnormal MPI 102 (13.6%) than men 183 (25.6%), p <0.01. Subsequent angiography and revascularization rates were similar in women 38 (37.2%) and 5 (4.9%) and men 52 (28.4%) and 16 (8.7%), p = 0.12, p = 0.23, respectively. After median follow-up of 6 months, myocardial infarction rates were similar in women 3 (2.9%) and men 7 (3.8%), p = 0.67. Death rates were similar in women 8 (7.8%) and men 18 (9.8%), p = 0.57. The most common clinical scenario designated as rarely appropriate was in those with low pretest probability of coronary artery disease, who have interpretable electrocardiogram and are able to exercise in women 58 (49.1%) and men 21 (33.8%). In conclusion, based on the most contemporary appropriate use criteria publication, rarely appropriate use of MPI remains higher in women than that in men. This phenomenon was mostly observed in low-risk patients who can exercise.
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